HTA of Atrial Fibrillation Screening

The Health Information and Quality Authority (HIQA) has published a health technology assessment which finds that a national screening programme for atrial fibrillation for over 65s in primary care would likely be cost-effective in Ireland. Atrial fibrillation screening aims to detect the risk of stroke in an individual as early as possible.

Implementation of an atrial fibrillation screening programme is among the recommendations contained in the National Cardiovascular Policy 2010-2019.

Purpose

The aim of this assessment was to examine the clinical and cost-effectiveness of a national screening programme for atrial fibrillation for all people aged over 65 years in Ireland, as well as examining the budget impact and resource implications associated with screening.

Background

Atrial fibrillation is the most common abnormal heart rhythm seen in general practice and is associated with a fivefold increase in the risk of stroke. Strokes related to atrial fibrillation are also more severe, with twice the death rate of non-atrial fibrillation related strokes and greater functional deficits for those who do survive. There are about 8,000 strokes in Ireland annually, approximately a third of which are associated with atrial fibrillation. Atrial fibrillation screening aims to detect the risk of stroke in an individual as early as possible so they can benefit from treatment designed to reduce their risk of stroke.

Methodology

A systematic review of the evidence was carried out to synthesise the available literature on the clinical effectiveness of screening. A decision analysis model was developed to estimate that impact of an Irish screening programme on increasing AF detection rates, and the corresponding decrease in stroke incidence as a result of antithrombotic therapy, as well as the cost effectiveness of a national screening programme.